Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy

Etan OrgelChildren’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA; ;Jonathan Jaques Children’s Cancer Center, Miller Children’s Hospital Long Beach, Long Beach, CA, USA; ;Department of Pediatrics, University of Southern California, Los Angeles, CA, USA; Correspondence[email protected]

Nicole M. MueskeChildren’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA;

Richard SpostoChildren’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA; ;Department of Pediatrics, University of Southern California, Los Angeles, CA, USA;

Vicente GilsanzDepartment of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA;

David R. FreyerChildren’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA; ;Department of Pediatrics, University of Southern California, Los Angeles, CA, USA;

Steven D. MittelmanDepartment of Pediatrics, University of Southern California, Los Angeles, CA, USA; ;Center for Endocrinology, Children’s Hospital Los Angeles, Los Angeles, CA, USA

Abstract

Obesity as defined by body mass index percentile (BMI%) is strongly associated with relapse and poorer survival in childhood ALL. Whether BMI% accurately reflects body fat percentage (BF%) in this population is unknown. We conducted a prospective study assessing body composition during frontline ALL therapy. Dual-energy X-ray absorptiometry measured BF% and lean muscle mass (LMM) at diagnosis, end of Induction, and end of Delayed Intensification. Sarcopenic obesity (gain in BF% with loss of LMM) was surprisingly common during ALL treatment, resulting in poor correlation between changes in BMI% (expressed as Z-score) and BF% overall (r = −0.05) and within patients (r = −0.09). BMI Z-score and BF% changed in opposite directions in >50% of interval assessments. While BMI% at diagnosis is a suitable predictor of obesity/BF% for epidemiological studies, change in BMI% (as expressed as Z-score) does not reflect body composition. Studies evaluating obesity in leukemia should consider using direct measures of body composition.

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Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at https://doi.org/10.3109/10428194.2015.1136741.

The authors report that they have no conflicts of interest. This work was supported by a Translational Research Program grant from the Leukemia and Lymphoma Society (LLS-6249-11), Hyundai Hope on Wheels Foundation, the National Center for Advancing Translational Sciences/NIH (UL1TR000130) via the Southern California Clinical and Translational Science Institute, and funds from The Saban Research Institute.

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Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy

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Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy

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